Removing Indicators

There have been a couple of new pieces of research in the last week or so relating to the QOF. I am trying to track down a copy of the this month's BJGP but fortunately there is free access to research in the BMJ and the paper The impact of removing financial incentives from clinical quality indicators. Lester et al.

The paper looks at the removal of incentive payments in California and, at the risk of spoiling the end for you, finds that there is a decrease in achievement when the incentives are withdrawn. In fact this decline is continuous over the years so things get worse. Comparisons are drawn with the UK and QOF although there are differences. In the US the payments rarely affect the clinicians directly but rather their employer. There were other programmes associated with the incentive payments that could have made a difference. Things not mentioned in the paper are that the incentives tend to be higher in the UK as a proportion of funding. Additionally most of the targets incentivised were fairly uncontroversial (cervical screening, diabetes control) whilst there is much more scepticism amongst clinicians about some of the QOF targets.

In general though the paper is a pretty easy read everyone except possibly for the NICE QOF advisory committee. Of course we won't really know what happens in the UK until it actually happens and has a chance to work through the system. As the earliest indicators will be removed is the 2011/12 year we won't really know until after the Olympics. Until then this is our best clue.